![]() 1, 3, 5, 6, 7 Peanut allergy is the most common nut allergy. 1, 2, 3, 4 There is a large variation in prevalence reported in different countries, ie, from 0.05% to 4.9% for tree nut and between 0.5% and 3% for peanut. The estimated prevalence of peanut/tree nut allergies is approximatively 2%. Peanut and Tree nut (TN) allergies are one of the most common food allergies worldwide and constitute a major public health problem. Oral immunotherapy is increasingly proposed as an alternative management strategy. Regarding treatment, avoidance remains the cornerstone of management of nut allergy. Thus, diagnosis remains mainly based on the oral food challenge, which is considered as the gold standard. The basophil activation test has been suggested to be useful but is still used mainly as a research tool. ![]() The use of component resolved diagnosis leads to major improvement of diagnosis, particularly to distinguish between primary and secondary nut allergies. However, diagnosis of nut allergy is particularly difficult due to co-sensitization leading to high rate of false positive skin prick tests and/or specific IgE to whole allergen extracts. As opposed to the avoidance of all nuts, this approach is currently proposed in several tertiary allergy centers. Recently, it has been demonstrated that a significant proportion of nut allergic patients are able to tolerate other nuts. Nut allergies tend to persist into adulthood and consequently have a high impact on quality of life. In addition, the food consumption modality (ie, raw versus roasted) plays a major role, as heat treatment has the capacity to modify the allergenicity of nuts and legumes. ![]() These large variations can be explained by differences in the age of included patients and the geographical region. Epidemiological data have shown that the prevalence ranges between 0.05% and 4.9% for tree nut and between 0.5% and 3% for peanut. These allergens can be found also in cashew nut and mango seed but not in mango pulp.Peanut/tree nut allergy is common and has been associated with particularly severe reactions. Pistachio nut contains several protein allergens able to trigger type I hypersensitivity reactions. Crossreactivity was also found between pistachio nut and mango seed but not with mango pulp. RAST inhibition demonstrated common antigenic determinants between pistachio and cashew nut. On immunoblotting, serum from both patients recognized several pistachio and cashew allergens with a molecular weight ranging from < 14.2-70 kDa. RAST was positive for pistachio and cashew in both patients. Skin tests were positive for pistachio and cashew in the two children and for mango seed in one. Crossreactivity between pistachio and the other Anacardiaceae was studied by RAST inhibition. The allergenic profile of pistachio and cashew was analyzed by sodium dodecyl sulfatepolyacrylamide gel electrophoresis (SDS-PAGE) followed by immunoblotting. ![]() Presence of specific IgE for pistachio and cashew nut and for mango seed and pulp was determined by skin tests and radioallergosorbent assay (RAST). Identification of immunoallergens present in pistachio nut and analysis of crossreactive antigens in other members of the same plant family, specifically cashew and mango. For this reason two patients with allergy towards pistachio nut (a member of the Anacardiaceae family) have been studied. Anaphylaxis against Anacardiaceae nuts is uncommon and the allergens involved still poorly characterized. ![]()
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